This document provides an overview of depression, including its definition, types, epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, investigations, and treatment. Depression is defined as a common mental disorder characterized by depressed mood, loss of interest, feelings of guilt, sleep disturbances, low energy, and poor concentration. Major types include major depressive disorder, bipolar disorder, dysthymic disorder, and situational depression. Depression affects over 350 million people globally and is a leading cause of disability. Causes may include genetic, environmental, biochemical and neurological factors. Treatment involves antidepressant medications like SSRIs, TCAs, and MAOIs as well as psychotherapy and other non-pharmacological approaches.
mania is an alteration in mood that is characterized by extreme happiness, extreme irritability, hyperactivity, little or no need for sleep. the main etiological factors include biological factors, biochemical influences, physiological factors, and psycho social theories. mania is broadly classified into three categories- hypo mania, acute mania and delirious mania. there are three types of treatment for mania- pharmacological treatment, psycho-social treatment and ECT.
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and disordered thinking and behaviour.
Contrary to some popular belief, schizophrenia is not split personality or multiple personality. The word “schizophrenia” does mean “split mind,” but it refers to a disruption of the usual balance of emotions and thinking (Mayo, 2013).
Schizophrenia is a chronic condition, requiring lifelong treatment.
mania is an alteration in mood that is characterized by extreme happiness, extreme irritability, hyperactivity, little or no need for sleep. the main etiological factors include biological factors, biochemical influences, physiological factors, and psycho social theories. mania is broadly classified into three categories- hypo mania, acute mania and delirious mania. there are three types of treatment for mania- pharmacological treatment, psycho-social treatment and ECT.
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and disordered thinking and behaviour.
Contrary to some popular belief, schizophrenia is not split personality or multiple personality. The word “schizophrenia” does mean “split mind,” but it refers to a disruption of the usual balance of emotions and thinking (Mayo, 2013).
Schizophrenia is a chronic condition, requiring lifelong treatment.
obsessive-compulsive disorder is a mental disorder whose main symptoms include obsessions and compulsions, driving the person to engage in unwanted, often-times distress behaviors or thoughts. The obsessions are usually related to a sense of harm, risk or injury. The common Obsessions include concern about contamination, doubt, fear of loss or letting go, fear of physically injuring someone.It’s treatment is done through a combination of psychiatric medications and psychotherapy.
Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.
An obsession is defined as an idea, impulse, or image which intrude into the conscious aware repeatedly.
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
This ppt will provide a complete information on the topic Depression. It Will also provide the types of depression, pathophysiology involved, causes, drugs used in Depression and its management.
obsessive-compulsive disorder is a mental disorder whose main symptoms include obsessions and compulsions, driving the person to engage in unwanted, often-times distress behaviors or thoughts. The obsessions are usually related to a sense of harm, risk or injury. The common Obsessions include concern about contamination, doubt, fear of loss or letting go, fear of physically injuring someone.It’s treatment is done through a combination of psychiatric medications and psychotherapy.
Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.
An obsession is defined as an idea, impulse, or image which intrude into the conscious aware repeatedly.
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
This ppt will provide a complete information on the topic Depression. It Will also provide the types of depression, pathophysiology involved, causes, drugs used in Depression and its management.
Background of organ transplant infrastructure in the US. Some history. Definitions. Nursing Care of the transplant patient in hospital, and home settings. Intended for senior level nursing students in an ADN program
Depression by Dr Iqra Osman Abdullahi.MDiqra osman
DEPRESSION
Dr.Iqra Osman
1.CONTENTS
INTRODUCTION
DEFINITION
TYPES OF DEPRESSION
EPIDEMIOLOGY
ETIOLOGY
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
DIAGNOSIS
INVESTIGATIONS
TREATMENT
CONCLUSION
REFERENCES
2.INTRODUCTION
Depression is a affective disorders.
Affective disorders : mental illnesses characterized by pathological changes in mood.
Depression : pathologically depressed mood
3.DEFINITION
DEPRESSION (By WHO) : Common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self- worth, disturbed sleep or appetite, low energy, and poor concentration.
4.TYPES OF DEPRESSION
Major depressive disorder : recurrence of long episodes of low moods, or one extended episode that seems to be ‘never-ending.
Atypical depression
Post partum depression
Catatonic depression
Seasonal affective disorder
Melancholic depression
5.Manic depression (bipolar disorder)
Four ‘Episodes’ of Bipolar Disorder
depressive episode
manic episodes
hypomanic episode
mixed-mood states
6.Dysthymic depression
lasts a long time but involves less severe symptoms.
lead a normal life, but we may not be functioning well or feeling good
Situational depression
Psychotic depression
Endogenous depression
7.EPIDEMIOLOGY
Globally more than 350 million people of all ages suffer from depression. (WHO)
For the age group 15-44 major depression is the leading cause of disability in the U.S.
Women are nearly twice as likely to suffer from a major depressive disorder than men are.
With age the symptoms of depression become even more severe.
About thirty percent of people with depressive illnesses attempt suicide.
8.ETIOLOGY
Genetic cause
Environmental factors
Biochemical factors : Biochemical theory of depression postulates a deficiency of neurotransmitters in certain areas of the brain (noradrenaline, serotonin, and dopamine).
Dopaminergic activity : reduced in case of depression, over activity in mania.
Endocrine factors
- hypothyroidism, cushing’s syndrome etc
9.Abuse of Drugs or Alcohol
Hormone Level Changes
Physical illness and side effects of medications
DRUGS
Analgesics
Antidepressants
Antihypertensives
Anticonvulsants
Benzodiazipine withdrawal
Antipsychotics
10.PHYSICAL ILLNESS
Viral illness
Carcinoma
Neurological disorders
Thyroid disease
Multiple sclerosis
Pernicious anaemia
Diabetes
Systemic lupus erythematosus
Addison’s disease
11.PATHOPHYSIOLOGY
The Biogenic Amine Hypothesis
The Receptor Sensitivity Hypothesis
The Serotonin-only Hypothesis
The Permissive Hypothesis
The Electrolyte Membrane Hypothesis
The Neuroendocrine Hypothesis
12.The Biogenic Amine Hypothesis
- caused by a deficiency of monoamines, particularly noradrenaline and serotonin.
cannot explain the delay in time of onset of clinical relief of depression of up to 6-8 weeks.
The Receptor Sensitivity Hypothesis
depression is the result of a pathological alteration (supersensitivity and up-regulation) in receptor sites.
- TCAs or MAOIs causes desensitizatio
Depression is a mental disorder and has become most common in recent years. This slide or presentation deals with all types of aetiologies of depression, theories that are involved in development of depression, pathophysiology of drepression, various classes anti-depressant their pharmacology with the adverse events or effects. This also gives a brief note on difference between depression and sadness.
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All about antidepressants
Types
Side effects
Uses
Efficacy
Choosing
In pregnancy and nursing
Alternatives
How they work
Taking effect
Treatment duration
Summary
Antidepressants can help relieve the symptoms of depression. They can also help to treat social anxiety disorder, other anxiety disorders, and seasonal affective disorder.
They work by correcting chemical imbalances of neurotransmitters in the brain. Experts believe these are responsible for changes in mood and behavior.
This article will cover the different types of antidepressants, how they work, their side effects, other uses, and alternative options.
Types
blackCAT/Getty Images
Doctors tend to divide antidepressants into different types. These include:
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are a first-line treatment option for depression.
Examples of SSRIs include:
citalopram (Celexa)
escitalopram (Lexapro)
fluoxetine (Prozac, Sarafem)
fluvoxamine (Luvox)
paroxetine (Paxil)
sertraline (Zoloft)
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
SNRIs are a newer class of antidepressant compared with SSRIs. However, they work in a similar way.
Doctors may prescribe SNRIs for:
attention deficit hyperactivity disorder (ADHD)
obsessive-compulsive disorder (OCD)
anxiety disorders
menopausal symptoms
fibromyalgia
chronic neuropathic pain
Examples of SNRIs include:
duloxetine (Cymbalta)
venlafaxine (Effexor XR)
desvenlafaxine (Pristiq)
Tricyclic antidepressants (TCAs)
Doctors may recommend TCAs for depression, fibromyalgia, some types of anxi
This slide is made for educational and academic purpose for Pharmacy, Medical and paramedical students. This slide is concerned with a Psychiatric disorder namley Depression.
This slide contains full pathophysiology of Depression. This slide is prepared in accordance with D.pharm 2nd year syllabus in the subject named Pharmacotherapeutics. Topics included are Definition, etilogy, pathophysiology, etiopathogenesis, diagnosis, clinical manifestations, non pharmacological and pharmacological treatment of Depression . Various hypothesis given to explain depression are also included.
This presentation provides all the relevant information about mental depression and anti-depressants. It will be useful to students of medicine, pharmacology, pharmacy, and pharmaceutical industry.
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4. INTRODUCTION
• Depression is a affective disorders.
• Affective disorders : mental illnesses characterized
by pathological changes in mood.
• Depression : pathologically depressed mood
5. DEFINITION
• DEPRESSION (By WHO) : Common mental
disorder that presents with depressed mood, loss of
interest or pleasure, feelings of guilt or low self-
worth, disturbed sleep or appetite, low energy, and
poor concentration.
6. TYPES OF DEPRESSION
• Major depressive disorder : recurrence of long
episodes of low moods, or one extended episode that
seems to be ‘never-ending.
- Atypical depression
- Post partum depression
- Catatonic depression
- Seasonal affective disorder
- Melancholic depression
7. • Manic depression (bipolar disorder)
Four ‘Episodes’ of Bipolar Disorder
- depressive episode
- manic episodes
- hypomanic episode
- mixed-mood states
8. • Dysthymic depression
- lasts a long time but involves less
severe symptoms.
- lead a normal life, but we may not be
functioning well or feeling good
• Situational depression
• Psychotic depression
• Endogenous depression
9. EPIDEMIOLOGY
• Globally more than 350 million people of all ages
suffer from depression. (WHO)
• For the age group 15-44 major depression is the
leading cause of disability in the U.S.
• Women are nearly twice as likely to suffer from a
major depressive disorder than men are.
• With age the symptoms of depression become even
more severe.
• About thirty percent of people with depressive
illnesses attempt suicide.
10. ETIOLOGY
• Genetic cause
• Environmental factors
• Biochemical factors : Biochemical theory of
depression postulates a deficiency of
neurotransmitters in certain areas of the brain
(noradrenaline, serotonin, and dopamine).
• Dopaminergic activity : reduced in case of
depression, over activity in mania.
• Endocrine factors
- hypothyroidism, cushing’s syndrome etc
11. • Abuse of Drugs or Alcohol
• Hormone Level Changes
• Physical illness and side effects of medications
DRUGS
• Analgesics
• Antidepressants
• Antihypertensives
• Anticonvulsants
• Benzodiazipine withdrawal
• Antipsychotics
13. PATHOPHYSIOLOGY
• The Biogenic Amine Hypothesis
• The Receptor Sensitivity Hypothesis
• The Serotonin-only Hypothesis
• The Permissive Hypothesis
• The Electrolyte Membrane Hypothesis
• The Neuroendocrine Hypothesis
14. • The Biogenic Amine Hypothesis
- caused by a deficiency of monoamines,
particularly noradrenaline and serotonin.
- cannot explain the delay in time of onset of
clinical relief of depression of up to 6-8 weeks.
• The Receptor Sensitivity Hypothesis
- depression is the result of a pathological
alteration (supersensitivity and up-regulation) in
receptor sites.
- TCAs or MAOIs causes desensitization (the
uncoupling of receptor sites) and possibly down-
regulation (a decrease in the number of receptor sites).
15. • The Serotonin-only Hypothesis
- emphasizes the role of serotonin in depression
and downplays noradrenaline.
- But the serotonin-only theory has shortcomings:
- it does not explain why there is a delay in
onset of clinical relief
- it does not explain the role of NA in
depression.
16. • The Permissive Hypothesis
- the control of emotional behavior results from a
balance between noradrenaline and serotonin.
- If serotonin and noradrenaline falls to
abnormally low levels, the patient becomes depressed.
- If the level of serotonin falls and the level of
noradrenaline becomes abnormally high, the patient
becomes manic.
17. • The Electrolyte Membrane Hypothesis
- hypocalcemia may be associated with mania.
- hypercalcemia is associated with depression.
• The Neuroendocrine Hypothesis
- pathological mood states are explained or
contributed to by altered endocrine function.
18. CLINICAL MANIFESTATIONS
• DEPRESSIONS
o Thinking is pessimistic and in some cases suicidal.
o In severe cases psychotic symptoms such as
hallucinations or delusions may be present.
o Insomnia or hypersomnia, libido, weight loss, loss of
appetite.
o Intellectual or cognitive symptoms include a
decreased ability to concentrate, slowed thinking, & a
poor memory for recent events.
19.
20. DIAGNOSIS
• ICD 10 Diagnostic criteria for a depressive
episode {who}
USUAL SYMPTOMS
• Depressed mood.
• Loss of interest and enjoyment.
• Reduced energy leading to increased
fatiguability and diminished activity.
21. COMMON SYMPTOMS
• Reduced concentration and attention.
• Reduced self esteem and self confidence.
• Ideas of guilt and unworthiness.
• Bleak and pessimistic views of future .
• Ideas or acts of self harm or suicide.
• Disturbed sleep.
• Diminished appetite.
22. MILD DEPRESSIVE EPISODE
• For at least 2 weeks, at least two of the usual
symptoms of a depressive episode plus at least two
common symptoms.
MODERATE DEPRESSIVE EPISODE
• For at least 2 weeks, at least two or three of the
usual symptoms of a depressive episode plus at
least three of the common symtoms.
23. SEVERE DEPRESSIVE EPISODE
• For at least 2 weeks all three of the usual
symptoms of a depressive episode plus at least 4
of the common symptoms some of which should be
of severe intensity.
27. MAO Inhibitors
• Drugs act by increasing the local availability of NA or
5 HT.
• MAO is a Mitochondrial Enzyme involved in
Oxidative deamination of these amines.
o MAO-A: Peripheral nerve endings, Intestine and
Placenta (5-HT and NA).
o MAO-B: Brain and in Platelets (Dopamine).
o Selective MAO-A inhibitors (RIMA) have
antidepressant property (eg:Moclobemide).
28. • Side effects : postural hypotension, weight gain,
atropine like effects and CNS stimulation.
• Severe hypertensive response to tyramine containing
foods-cheese reaction
• Drug interaction : Ephedrine, Reserpine.
• Moclobemide (Rimarex) : 150 mg BDS-TDS
Max : 600 mg/day
• Less ADR as compared to irreversible MAOI
29. TCAs
• NA, 5 HT and Dopamine are present in Nerve
endings
• Normally, there are reuptake mechanism and
termination of action.
• TCAs inhibit reuptake and make more monoamines
available for action.
• In most TCA, other receptors (incl. those outside the
CNS) are also affected: blockade of H1-receptor,
Alpha-receptors, M-receptors.
32. SSRIs
• First line drug in depression.
• Relatively safe and better patient acceptability.
• Some patients not responding to TCAs may respond
with SSRIs.
• SSRIs inhibit the reuptake mechanism and make
more 5 HT available for action.
33. Relative advantages:
– No sedation, so no
cognitive or
psychomotor function
interference
– No anicholinergic
effects
– No alpha-blocking
action, so no postural
hypotension and suits
for elderly
– No seizure induction
– No arrhythmia
Drawbacks:
– Nausea is common
– Interfere with
ejaculation
– Insomnia, dyskinesia,
headache and
diarrhoea
– Impairment of platelet
function – epistaxis
35. Atypical antidepressants
1. Trazodone:
• Weak 5-HT uptake block, α – block, 5-HT2 antagonist
• No arrhythmia
• No seizure
• ADRs: Postural Hypotension
2. Venlafaxine:
• SNRI (Serotonin and NA uptake inhibitor)
• Fast in action
• No cholinergic, adrenergic and histaminic interference
• Raising of BP
36. 3. Mianserin
• Not inhibiting either NA or 5 HT uptake, but blocks
presynaptic alpha-2 receptors- increase release of NA
in brain.
• ADR : Blood dyscrasias, liver dysfunction.
4. Bupropion
• Inhibitor of DA and NA uptake (NDRI)
• Non-sedative but excitant property
• Used in depression and cessation of smoking
• Seizure may precipitated
37.
38.
39. NON – PHARMACOLOGIC THERAPY
• LIFESTYLE CHANGES
o Stress reduction
o Social support
o Sleep
• PSYCHOTHERAPY
o Cognitive behavioral therapy
o Interpersonal therapy
o Psychodynamic therapy
40. • ELECTROCONVULSIVE THERAPY – ECT
o Safe & effective disorder for all subtypes of major
depressive disorder.
o ADR : Cognitive dysfunction, cardiovascular
dysfunction, prolonged apnoea etc.
41. CONCLUSION
• Affective disorders remain one of the most commonly
occurring mental illnesses in adults.
• It is often undiagnosed and untreated.
• Both pharmacological and nonpharmacological
interventions acts as cornerstone in the treatment of
affective disorders.
• Pharmacist plays an important role in accomplishing
these treatment goals.
42. REFERENCES
• Clinical pharmacy and therapeutics
by Roger walker, Cate whittlesca
(page no : 424-435)
• Text book of therapeutics
by Eric T Herfintal
• Pharmacotherapy handbook
by Joseph T Dipiro (page no :1235-1253)
• Essentials of medical pharmacology
by K D Tripathi (page no : 423-444)
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Only for educational purpose